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Acreditação, benchmarking e mortalidade
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RESUMO - Face ao interesse crescente em processos de acreditação
e/ou benchmarking, o presente estudo procura ver até que
ponto a participação nestes projectos influencia a qualidade
dos cuidados prestados, nomeadamente em termos de
taxas de mortalidade intra-hospitalar ajustadas pelo risco.
Para este efeito, foram analisados os valores dos hospitais
públicos portugueses envolvidos nos processos de acreditação,
pelo HQS ou pela JCI, bem como no projecto de
benchmarking IQIP. Para calcular os valores por hospital
das taxas de mortalidade intra-hospitalar ajustadas pelo
risco, foram utilizadas as bases de dados dos resumos de
alta para os anos de 2001 a 2006. Os valores obtidos foram
ajustados para a gravidade dos doentes. Não foram encontradas
diferenças estatisticamente significativas entre os
hospitais envolvidos e os não envolvidos em processos de
acreditação e/ou de benchmarking, em termos da variável
dependente escolhida. Uma das inovações deste trabalho é
o facto de olhar para processos ainda não avaliados nesta
perspectiva. Embora se acredite que os processos de acreditação
podem trazer benefícios consideráveis às instituições
que a eles se submetem, numa altura em que, nacional
e internacionalmente, se começa a solicitar evidência da
efectividade e custo-efectividade dos mesmos, para os decisores,
políticos ou gestores, é importante saber se o investimento
num processo de acreditação ou de benchmarking
vale ou não a pena ser generalizado, e, na presença de
várias opções, qual é a que promete melhores resultados.
A resposta, neste momento e neste contexto, é que nenhuma
parece estar associada a um melhor desempenho. O presente
estudo deve suscitar uma reflexão sobre o impacto
destes diferentes processos nos hospitais portugueses, para
ajudar a definir para o futuro uma estratégia mais fundamentada
e mais universal.
ABSTRACT - Given the growing interest in benchmarking and accreditation projects, this study assesses the extent to which participation in these impacts the quality of health care, as measured by riskadjusted in-hospital mortality. The rates of public sector hospitals involved in the HQS and/or JCI accreditation programs, as well as in the IQIP benchmarking scheme, were analysed. Hospital discharge databases from 2001 to 2006 were used to calculate in-hospital mortality. Results were adjusted for patient severity. No statistically significant differences were found between participating and non-participating hospitals, in terms of mortality. One of the strengths of the study is looking at processes not yet analysed in this perspective. Although the authors believe that accreditation and benchmarking programs can bring substantial benefits to the institutions involved in them, at a time when, nationally and internationally, evidence of their effectiveness and costeffectiveness starts being called for, decision makers, be they politicians or managers, need to know if the investment in these programs is worth being generalized, and, given competing options, which looks more promising. The answer, at this moment and in this context, is that none seems associated with better performance. This study should promote a reflection on the impact of these programs in Portuguese hospitals, to help define a more supported and universal strategy for the future.
ABSTRACT - Given the growing interest in benchmarking and accreditation projects, this study assesses the extent to which participation in these impacts the quality of health care, as measured by riskadjusted in-hospital mortality. The rates of public sector hospitals involved in the HQS and/or JCI accreditation programs, as well as in the IQIP benchmarking scheme, were analysed. Hospital discharge databases from 2001 to 2006 were used to calculate in-hospital mortality. Results were adjusted for patient severity. No statistically significant differences were found between participating and non-participating hospitals, in terms of mortality. One of the strengths of the study is looking at processes not yet analysed in this perspective. Although the authors believe that accreditation and benchmarking programs can bring substantial benefits to the institutions involved in them, at a time when, nationally and internationally, evidence of their effectiveness and costeffectiveness starts being called for, decision makers, be they politicians or managers, need to know if the investment in these programs is worth being generalized, and, given competing options, which looks more promising. The answer, at this moment and in this context, is that none seems associated with better performance. This study should promote a reflection on the impact of these programs in Portuguese hospitals, to help define a more supported and universal strategy for the future.
Descrição
Palavras-chave
Acreditação Benchmarking Mortalidade Qualidade Estrutura Processos Resultados Accreditation Mortality Quality Structure Processes Results
Contexto Educativo
Citação
Editora
Universidade Nova de Lisboa, Escola Nacional de Saúde Pública